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Graftjacket Patient Assistance Programs

Graftjacket: Apply for prescription assistance below

If you are eligible, the programs below can help you afford Graftjacket. Review the information to see if you qualify. The applications are available in Adobe PDF format and should be mailed directly to the provider of the patient assistance program.

If you have any questions, please call the telephone number for the program (not PharmacyChecker.com) or go to the program website.

Doctor's Action
Will be discussed with patient and Doctor after request is received

Applicant's Action
Call for information or inform doctor that he/she is in need

Decision Communicated
Patient and Doctor notified in writing

Decision Timeframe
Within 48 hours

Medication

Amount/Supply
Not applicable

Sent To
Patient sent card to be used at pharmacy

Delivery Time
Once approved; shipped same day

Refill Proces
Patient presents voucher/card to pharmacy for each refill

Limit
None

Re-application
New application every 12 months

Additional Information

*Patients must have health insurance and their insurance must cover the qualifying medication for which they seek assistance.
Call for most recent medications as the list is subject to change and the medication for which you are seeking assistance must treat the disease directly.
Note: All new enrollment is now done electronically or over the phone. Contact program for details.